IN SOME WAYS, health care providers in the more far-flung regions of Massachusetts are running into the same problems as everyone else, like the primary care crisis, specialist staffing shortages, and coverage fears from looming Medicaid cuts. Adding in narrow roadways, a dispersed and aging population, and fierce New England hill town weather only makes the access math harder. 

This week on The Codcast, CommonWealth Beacon reporter Jennifer Smith talks with Michael Leary, director of media relations for Berkshire Health Systems. The system has three hospitals, including the 298-bed Berkshire Medical Center in Pittsfield as the county’s primary hospital. Two critical access hospitals – Fairview Hospital in Great Barrington and North Adams Regional Hospital – anchor the southern and northern edges of the county. 

They dive into what makes Berkshire County such a complicated puzzle of health care access, even with the re-opening of the North Adams hospital after a decade of closure.  

“I vividly remember the day” the hospital closed, said Leary, a North Adams resident for over 30 years. A good friend worked as his communications counterpart at North Adams Regional, which at the time was managed by the separate Northern Berkshire Healthcare. 

Leary said his friend called on a Tuesday morning, “and said, ‘You know, I just wanna let you know North Adams Regional is closing.’ And I said, ‘When?’ And he said, ‘Friday,’ which was a shock to everybody.” 

The hospital was not financially sustainable because it did not qualify for critical access hospital status, which comes with dedicated federal Medicaid and Medicare funding. At the time, Leary noted, federal legislation said that if the center was within a certain number of minutes or miles from an acute care hospital, it did not qualify. North Adams “fell right into the narrow edges of that” with Berkshire Medical Center and a hospital in Bennington, Vermont. 

Through finagling by US Rep. Richard Neal, the language was changed to include a carve out for hospitals accessible by just a two-way road like North Adams. With the designation in hand, the facility re-opened a decade after closing. 

But access issues persist, Leary said. “Transportation is always an issue in the Berkshires due to the wide geography,” he said, “and the fact that we are limited with the type of rural main roads that we have here in the county.”  

And the dispersed population makes maintaining infrastructure like maternity units difficult. The North Adams hospital had a full maternity unit before its closure, but on re-opening as a critical access site it didn’t have the expected numbers that would make a maternity unit sustainable, Leary said. People looking for more than an OB/GYN have to travel to Pittsfield or further. 

The other open question is the impacts of federal funding cuts to Medicaid programing, which would not take effect until after the 2026 midterms. Berkshire Medical Center and Fairview Hospital will receive part of a $17 million allocation – with the specific hospital-by-hospital amount not yet released – from $122 million in state funding announced in September to shore up acute care hospitals. 

Berkshire Medical Systems has not publicly announced plans to pursue some of the $50 billion rural health fund included as part of the Trump tax law signed in July. 

“We are keeping a very close eye on [the Medicaid cuts] and whatever impact it would have here on the Berkshires,” Leary said. “We are very fortunate to have had a very good sustainable financial model for a number of years now. We consider ourselves to be a very good financial performer. It doesn’t mean that we’re not worried, it doesn’t mean that we’re not challenged, but we are keeping an eye on everything, and we will continue to serve our patients as best we can.” 

On the episode, Leary discusses the difficult geographic features of Berkshire County (2:45), challenges with recruiting staff (11:25), and health policy changes on the federal level (21:25).